Endothelial cell damage is characteristic for respiratory distress syndrome and development of bronchopulmonary dysplasia (BPD). Vascular endothelial growth factor (VEGF) is an endothelial mitogen that takes part in growth, maintenance, and repair of vascular endothelial cells. We measured VEGF in tracheal aspirate fluid (TAF) from 29 intubated preterm infants (GA 27.4±2.0 wk, BW 986±341 g) during the early postnatal period. VEGF in TAF increased from 0.2±0.1 ng/mL during the first day to 22.3±3.1 ng/mL on day 7. In plasma the mean concentration of VEGF during the first week was 0.04±0.007 ng/mL. In patients who developed BPD VEGF was lower during the second week (20.8±6.4 vs. 12.9±7.3 ng/mL, p<0.01). During the first week, VEGF concentration in TAF was higher in patients born to mothers with premature rupture of the membranes(16.4±2.3 vs. 11.4±1.6 ng/mL; p<0.01), or with chorioamnionitis (17.3±2.8 vs. 9.6±1.0 ng/mL; p<0.05). In contrast, pre-eclampsia of the mother was associated with lower VEGF during the first (5.2±1.3 vs. 10.3±8.4 ng/mL; p<0.01) and the second week (9.2±1.8 vs. 17.0±1.5 ng/mL; p<0.05). VEGF increases rapidly in the lungs of preterm infants during the first days of life. High VEGF is associated with lower risk for BPD. In the preterm infant VEGF may play a role in recovery from acute respiratory distress.